Journal List > J Korean Rheum Assoc > v.17(4) > 1003757

Ra, Kim, Ahn, and Kim: The Effect of Early Immunoglobulin Treatment on the Course of Kawasaki Disease

Abstract

Objective

Controversies exist as to whether early treatment for Kawasaki disease might increase the need for additional intravenous immunoglobulin (IVIG) treatment and whether it could reduce cardiac complications. We conducted this study to add useful clues, which could be helpful when setting up a treatment plan.

Methods

359 patients who were newly diagnosed with Kawasaki disease at Severance Hospital were divided into two groups; patients who received IVIG treatment within 3 days (group A) and those who received IVIG treatment after 3 days (groups B and C). We compared the laboratory data, fever duration, frequency of additional IVIG treatment, and echocardiography follow-up results.

Results

IVIG was administered 1.11±0.34 (mean±SD), 1.15±0.39, and 1.17±0.42 times in groups A, B, and C, respectively; p=0.29 (A vs. B), p=0.21 (A vs. C). The incidence of cardiac complications checked within the first 2 weeks from disease onset was 3.6%, 5.2%, and 5.1% in groups A, B, and C, respectively; p=0.52 (A vs. B), p=0.55 (A vs. C), and the values checked at 2 months were 3.6%, 5.6%, and 5.7% in groups A, B, and C, respectively; p=0.43 (A vs. B), p=0.43 (A vs. C).

Conclusion

Early IVIG treatment in patients with Kawasaki disease decreased fever duration and may prevent cardiac complications by limiting inflammation.

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Table 1.
Clinical features of the treatment groups
Group A (N=110) Group B (N=249) Group C (N=175) p-value
A vs B A vs C
Age (months) 27.5±21.2 35.3±26.2 33.0±26.2 <0.01 0.03
Sex 0.636 0.550 0.543 0.12 0.12
Fever duration before administration of IVIG (days) 2.38±0.82 6.04±2.77 4.78±0.70 <0.01 <0.01
Fever duration after administration of IVIG (days) 0.32±0.74 0.23±0.62 0.26±0.62 0.24 0.47
Total fever duration (days) 2.70±1.11 6.27±2.79 5.04±0.92 <0.01 <0.01
The number of times of IVIG administration 1.11±0.34 1.15±0.39 1.17±0.42 0.29 0.21
CAL Within 2 weeks from disease onset 4 (3.6%) 13 (5.2%) 9 (5.1%) 0.52 0.55
At 2 months from disease onset 4 (3.6%) 14 (5.6%) 10 (5.7%) 0.43 0.43

IVIG: intravenous intravenous immunoglobulin, CAL: coronary artery lesion

Table 2.
Laboratory values of the treatment groups
Group A (N=110) Group B (N=249) Group C (N=175) p-value
A vs B A vs C
WBC (/mm3) 13,132±4,974 13,013±4,940 12,747±4,878 0.86 0.71
ESR (mm/hour) Initial value 45.1±32.1 61.9±36.7 60.7±36.4 0.01 0.01
Increase after 3 days 22.8±27.8 17.6±28.3 17.3±28.4 0.17 0.18
CRP (mg/dL) Initial value 4.2±4.8 5.8±5.9 6.5±6.1 <0.01 <0.01
Increase after 3 days –2.5±2.7 –4.1±4.9 –4.6±5.1 <0.01 <0.01

WBC: white blood cell, ESR: erythrocyte sedimentation rate, CRP: c-reactive protein

Table 3.
Differences between patients who received IVIG treatment once and those who received IVIG more than twice
Number of times of IVIG administration p-value
1 (N±313) ≥2 (N±46)
Age (months) 33.6±25.7 28.0±19.0 0.08
Sex 0.59±0.49 0.50±0.51 0.26
CAL 0.05±0.36 0.28±0.83 0.44
Fever Before IVIG 4.91±2.93 4.98±2.65 0.89
duration After IVIG 0.18±0.46 0.76±1.30 <0.01
(days) Total 5.10±2.91 5.74±2.93 0.16
ESR (mm/hour) Initial value 56.1±36.5 60.5±33.6 0.44
Difference after 3 days 18.9±28.6 20.6±24.9 0.74
CRP (mg/dL) Initial value 5.4±5.8 4.6±4.3 0.38
Difference after 3 days –3.8±4.7 –3.0±3.6 0.32

IVIG: intravenous immunoglobulin, CAL: coronary artery lesion

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